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Hauch H, Kriwy P, Hahn A, Dettmeyer R, Zimmer KP, Neubauer B, Brill S, Vaillant V, de Laffolie J, Schaefer K, Tretiakowa I, Hach M, Sibelius U, Berthold D. Gastrointestinal Symptoms in Children With Life-Limiting Conditions Receiving Palliative Home Care. Front Pediatr 2021; 9:654531. [PMID: 33869119 PMCID: PMC8044350 DOI: 10.3389/fped.2021.654531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/04/2021] [Indexed: 01/06/2023] Open
Abstract
Context: Children with life-limiting diseases suffer from gastrointestinal (GI) symptoms. Since the introduction of specialized palliative home care (SPHC) in Germany, it is possible to care for these children at home. In phase 1 of care the aim is to stabilize the patient. In phase 2, terminal support is provided. Objectives: Analysis were performed of the differences between these phases. The causes and modalities/outcome of treatment were evaluated. Methods: A retrospective study was performed from 2014 to 2020. All home visits were analyzed with regard to the abovementioned symptoms, their causes, treatment and results. Results: In total, 149 children were included (45.9% female, mean age 8.17 ± 7.67 years), and 126 patients were evaluated. GI symptoms were common in both phases. Vomiting was more common in phase 2 (59.3 vs. 27.1%; p < 0.001). After therapy, the proportion of asymptomatic children in phase 1 increased from 40.1 to 75.7%; (p < 0.001). Constipation was present in 52.3% (phase 1) and 54.1% (phase 2). After treatment, the proportion of asymptomatic patients increased from 47.3 to 75.7% in phase 1 (p < 0.001), and grade 3 constipation was reduced from 33.9 to 15% in phase 2 (p < 0.05). Conclusion: Painful GI symptoms occur in both palliative care phases but are more common in phase 2. The severity and frequency can usually be controlled at home. The study limitations were the retrospective design and small number of patients, but the study had a representative population, good data quality and a unique perspective on the reality of outpatient pediatric palliative care in Germany.
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Affiliation(s)
- Holger Hauch
- Palliative Care Team for Children, University Children's Hospital, Justus Liebig University Giessen, Giessen, Germany.,Department for Pediatrics, Hospital of Bad Hersfeld, Bad Hersfeld, Germany
| | - Peter Kriwy
- Institute for Sociology, Technical University of Chemnitz, Chemnitz, Germany
| | - Andreas Hahn
- Pediatric Neurology, University Children's Hospital, Justus Liebig University Giessen, Giessen, Germany
| | - Reinhard Dettmeyer
- Institute for Forensic Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Klaus-Peter Zimmer
- General Pediatrics and Neonatology, University Children's Hospital, Justus Liebig University Giessen, Giessen, Germany
| | - Bernd Neubauer
- Pediatric Neurology, University Children's Hospital, Justus Liebig University Giessen, Giessen, Germany
| | - Sabine Brill
- Palliative Care Team for Children, University Children's Hospital, Justus Liebig University Giessen, Giessen, Germany
| | - Vera Vaillant
- Palliative Care Team for Children, University Children's Hospital, Justus Liebig University Giessen, Giessen, Germany
| | - Jan de Laffolie
- General Pediatrics and Neonatology, University Children's Hospital, Justus Liebig University Giessen, Giessen, Germany
| | - Kristine Schaefer
- Pediatric Oncology, University Children's Hospital, Justus Liebig University Giessen, Giessen, Germany
| | - Irina Tretiakowa
- Department for Pediatrics, Hospital of Bad Hersfeld, Bad Hersfeld, Germany
| | - Michaela Hach
- Association for Specialized Palliative Home Care, Wiesbaden, Germany
| | - Ulf Sibelius
- Internal Medicine IV/V, University Hospital, Justus Liebig University Giessen, Giessen, Germany
| | - Daniel Berthold
- Internal Medicine IV/V, University Hospital, Justus Liebig University Giessen, Giessen, Germany
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